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Knee arthroscopy/surgery at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
not published by hospital
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
not published by hospital
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$892.40 with United Healthcare Community Plan for Families vs $5,806.84 with Highmark BCBS of PA — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $892.40 | — |
| Highmark BCBS of PA | Medicare Advantage | $1,020.54 | — |
| UPMC Work Partners | Workers Comp | $2,034.51 | — |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $3,062.42 | — |
| AmeriHealth Caritas | Medicare | $3,093.35 | — |
| UPMC Health Plan | Managed Medicare | $3,093.35 | — |
| United Healthcare | Medicare | $3,093.35 | — |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $3,155.22 | — |
| UPMC Health Plan | CHIP | $3,269.34 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $3,340.51 | — |
| UPMC Health Plan | Commercial | $4,228.00 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $4,587.75 | — |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $5,806.84 | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Knee arthroscopy/surgery at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Northwest | Seneca | not published | $1,544.41 – $3,340.82 |
| UPMC Presbyterian | Pittsburgh | not published | $931.20 – $3,402.68 |
| UPMC St. Margaret | Pittsburgh | not published | $1,040.78 – $3,402.68 |
| UPMC Wellsboro | Wellsboro | not published | $993.28 – $2,034.51 |